title: Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy.
abstract: OBJECTIVE
  We examine how the level of experience acquired by the laparoscopist affects the outcome of laparoscopic adrenalectomy and nephrectomy, and what is necessary to avoid complications in these surgeries.
  
  
  METHODS
  We retrospectively evaluated the experience levels of 8 urological laparoscopists between 1991 and 1995. In addition, other cases that were converted to open surgery were collected from the institutes with which the 8 laparoscopists were affiliated.
  
  
  RESULTS
  The rates of conversion to open surgery were 6.4% in 204 cases of adrenalectomy and 14.3% in 63 of nephrectomy. Conversion rates were related to blood loss volume but not operative time. The major causes of conversion were bleeding in 45% of cases and adhesion in 34%. There were no mortalities. Mean operative time decreased significantly, reaching that of open surgery as the number of procedures increased up to 20 adrenalectomies and 10 nephrectomies. The volume of blood lost remained low from the early experience. Blood transfusion rates were 4.4% for adrenalectomy and 11.1% for nephrectomy.
  
  
  CONCLUSIONS
  Operative time of these procedures decreased significantly with surgeon experience and reached that of open surgery. Cases in which adhesion is anticipated should be restricted to avoid conversion. These laparoscopic procedures are acceptable as a standard operative techniques for adrenal and renal diseases.
authors.affiliation: Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Higashihara
authors.forename: S
authors.initials: S
authors.lastname: Baba
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
authors.forename: M
authors.initials: M
authors.lastname: Murai
authors.forename: H
authors.initials: H
authors.lastname: Go
authors.forename: M
authors.initials: M
authors.lastname: Takeda
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Fujita
authors.forename: Y
authors.initials: Y
authors.lastname: Ono
authors.forename: S
authors.initials: S
authors.lastname: Ohshima
authors.forename: T
authors.initials: T
authors.lastname: Matsuda
authors.forename: T
authors.initials: T
authors.lastname: Terachi
authors.forename: O
authors.initials: O
authors.lastname: Yoshida
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D006801:Humans; D007431:Intraoperative Complications; D007674:Kidney Diseases / Q000601:surgery; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome